Kev sib koom ua ke ntawm ntshav qab zib yog qhov tshwm sim ntau dua. Xws li cov kev tiv thaiv xav tau kev kho mob sai, uas yuav tsis tsuas yog ua rau cov txheej txheem rhuav tshem pov tseg, tab sis kuj tseem tso cai txhim kho cov kev mob ntawm cov leeg ua kom lub siab.
Cov kev coj ua uas ua rau muaj ntshav qab zib tsis txaus, hu ua pob txha-articular pathologies, uas yog cov ntshav ntawm cov ntshav qabzib tas li. Tom qab txhua tus, mob hyperglycemia muaj kev cuam tshuam tsis zoo rau txhua yam hauv nruab nrog cev thiab kab ke ntawm tus neeg.
Nws tau pom tias qhov kev xav ntau ntxiv ntawm cov piam thaj muaj feem cuam rau kev sib txuas ntawm sorbitol tsim hauv neurons thiab endothelial hlwb. Tawm tsam cov keeb kwm yav dhau los no, mob ntshav qab zib neuropathy feem ntau muaj.
Ib qho ntxiv, cov ua rau mob sib koom tes hauv cov ntshav qab zib tuaj yeem yog vim qhov hloov pauv ntawm cov nqaij sib txuas ua rau muaj kev cuam tshuam oxidative kev nyuaj siab thiab kev tsim cov dawb radicals. Thiab yog tias muaj cov tshuaj insulin tsis txaus, hloov pauv hauv cov khoom tiv thaiv tsis muaj zog tiv thaiv pob txha mos thiab pob txha.
Sib koom tes mob ntshav qab zib
Hauv cov kab mob hyperglycemia, cov pob qij txha muaj cuam tshuam sib txawv. Hauv qee kis, tus kabmob yog tshwm sim los ntawm kev ua haujlwm tsis zoo hauv microcirculation, nthuav dav ntawm cov nqaij sib txuas, lossis mob neuropathic. Thiab rheumatic syndromes feem ntau pom nyob rau hauv cov neeg mob nrog kev ua mob ntawm cov kab mob hloov khoom nruab nrog.
Muaj ntau cov kev muaj zawv plab muaj teeb meem. Cov no suav nrog:
- diffuse idiopathic pob txha hyperostosis;
- osteoporosis;
- ntshav qab zib mob sib kis.
Tsis tas li, nrog kev nce siab tas li ntawm cov piam thaj, ntau tus neeg mob pom cov tsos mob ntawm lub cev muaj peev xwm ntawm cov nqaij mos ntawm pob txha, nrog rau cov qhov txhab muaj xws li:
- Dupuytren kev cog lus;
- cov kab mob ntshav qab zib chiroartropathy (cyst);
- tenosynovitis ntawm lub pob flexor (ntiv tes tuav);
- nplaum capsulitis (periarthritis, loog ntawm lub xwb pwg).
Lwm qhov kev pheej hmoo ntawm ntshav qab zib yog mob hlwb. Cov no suav nrog amyotrophy, neuropathic mob caj dab (osteoarthropathy, Cov pob qij txha pob), sympathetic reflex dystrophy, carpal valve syndrome thiab ntau dua.
Txhawm rau kom tsis txhob tsim cov kev rau txim no, kuv thiab tus neeg mob tsis tas yuav siv tshuaj pleev, nws yog qhov tseem ceeb tshaj plaws rau kev kho mob kom raws sijhawm. Thiab txhawm rau ua kom cov ntshav qabzib ntau, cov tshuaj tiv thaiv kab mob xws li Metformin yuav tsum noj tsis tu ncua.
Tawm tsam keeb kwm ntawm lub sijhawm ntev txog kev mob ntshav qab zib (5-8 xyoos), ntau tus neeg mob pib mob ntshav qab zib osteoarthropathy. Thawj qhov tsos mob ntawm tus kab mob yog kuaj tau los ntawm ultrasound osteometry.
Feem ntau, tus kab mob cuam tshuam rau ntawm caj npab qis dua. Hauv 60% ntawm cov xwm txheej, tarsal-metatarsal pob qij txha koom nrog hauv cov txheej txheem pathological, thaum lub pob luj taws thiab metatarsophalangeal pob qij txha koom nrog tsawg dua (30%).
Qee zaum lub ntsag pob qij txha thiab lub hauv caug mob. Raws li txoj cai, txoj kev no yog ib-sab.
Cov cim ntawm osteoarthropathy yog qhov mob, o thiab deformation ntawm pob qij txha. Vim yog qhov kev ua txhaum ntawm rhiab, pob zeb thiab qhov tsis khov ntawm lub koov ntawm tus taw tshwm sim, uas feem ntau ua rau lawv txoj kev luv luv thiab deformation.
Kuj tseem yog ib qho kev cuam tshuam ntau dhau los ntawm tus mob hyperglycemia yog mob ko taw mob ko taw (SDS). Qhov no yog tus kab mob ko taw uas tsim tawm thaum pob txha, pob txha mos thiab cov nqaij mos, nrog rau cov hlab ntsha thiab cov leeg ntshav, cuam tshuam. Raws li qhov no, purulent necrotic cov txheej txheem tshwm sim hauv tus neeg mob thiab mob rau ntawm ob txhais ceg daim ntawv.
Feem ntau, SDS tshwm nyob rau cov neeg laus laus tiv thaiv keeb kwm ntawm cov mob ntshav qab zib mus ntev (los ntawm 15 xyoo). Hmoov tsis zoo, hauv 70% ntawm cov neeg mob, qhov muaj mob ntawm tus kab mob yuav tsum txiav tu ncua thiab qee zaum ib txhais ko taw yuav tsum cog rau.
Soj ntsuam cov tsos mob ntawm pathology yog o thiab hyperthermia ntawm taw. Thaum pib, mob tshwm sim nyob rau hauv qis, uas yuav tsum muaj qhov kev tshawb nrhiav qhov mob txawv txav nrog kev mob caj dab lossis mob txha mos.
Nyob rau hauv tus txheej txheem ntawm kev tsim tus kab mob, flattening ntawm ko taw tshwm sim. Thaum txog qib tom qab, mob neuropathy mob heev, thiab tsis muaj mob.
Feem ntau, nrog cov ntshav qab zib tas li ua rau kom mob ntshav qab zib, tus mob ntshav qab zib lub cev tsis muaj kev sib koom tes ntau tuaj yeem tshwm sim. Feem ntau cov me me thiab qee zaum cov pob qij txha loj yog immobilized.
Cov tsos mob ntawm OPS yog qhov mob uas tshwm sim thaum kev sib koom tes. Feem ntau, feem ntau tsis sib thooj interphalangeal thiab metacarpophalangeal pob qij txha muaj feem cuam tshuam, tsawg dua - lub luj tshib, ceg tawv, pob qij txha pob qij txha thiab pob taws.
Feem ntau, kuaj pom tus kab mob thaum tus neeg mob tsis tuaj yeem zawm nws ob txhais tes rau ib leeg. Feem ntau, cov tsos mob ntawm "thov Vajtswv txhais tes" pib tawm tsam keeb kwm ntawm lwm qhov kev hloov pauv rheumatic. Ntxiv mus, qhov tshwm sim ntawm OPS nyob ntawm lub sijhawm ntawm cov chav kawm mob ntshav qab zib thiab nws cov nyiaj tau los.
Lwm qhov kev pheej hmoo ntawm hyperglycemia yog lub xub pwg-lub xub pwg periarthritis. Cov kab mob no feem ntau ua ke nrog OPS syndrome, thiab qee zaum, nrog tenosynovitis ntawm xib teg. Txhawm rau tiv thaiv kev txhim kho ntawm cov kab mob no, nws yog ib qho tseem ceeb uas yuav tau soj ntsuam cov ntshav qabzib, thiab rau lawv qhov ib txwm ua, cov neeg mob uas tsis muaj cov tshuaj insulin yuav tsum tau haus tas li Metformin.
Feem ntau, lub caij nyoog ntev ntawm tus kab mob uas ua rau hyperglycemia pab txhawb kev hloov pauv ntawm pob txha kho. Nrog cov tshuaj insulin tsis txaus, qhov tshwm sim no cuam tshuam tsis zoo rau osteoblastic muaj nuj nqi.
Hauv ib nrab ntawm cov neeg mob, osteopenia thiab osteoporosis yog diffuse. Ntxiv mus, chav kawm ntawm cov pathologies siab tshaj qhov yuav ua rau muaj pob txha lov. Cov laj thawj uas yuav ua rau muaj kev txhim kho osteopenic syndrome:
- ntev decompensation ntawm carbohydrate metabolism;
- kev mob ntshav qab zib hauv cov neeg mob hnub nyoog qis dua 20 xyoo;
- mob ntshav qab zib rau ntau tshaj 10 xyoo.
Kev mob caj dab kuj yog ib qho mob ntxiv rau ntshav qab zib, tshwj xeeb tshaj yog rau cov neeg laus. Tus kab mob yog tus cwj pwm los ntawm cov tsos mob ntawm qhov mob siab nyob hauv kev sib koom tes, qhov kev ua txhaum ntawm nws txoj kev txav mus los thiab mob ntawm thaj chaw muaj kev cuam tshuam.
Tab sis yog tias muaj ntshav qab zib, kev noj zaub mov ua rau mob tag nrho cov pob qij txha thiab loog txhais ceg, yuav ua li cas thiab yuav kho cov mob li cas?
Kho kev ntsuas
Qhov tseem ceeb tshaj plaws rau kev tiv thaiv kev loj hlob ntawm kev sib koom tes ntawm cov kab mob sib koom tes yog tswj hwm qhov ntsuas nruab nrab (li 10 mmol / l) thoob plaws hnub. Txwv tsis pub, kho mob ko taw deformity thiab lwm yam mob ntshav qab zib yuav tsis muaj txiaj ntsig. Yog li, nws yog ib qho tseem ceeb kom noj cov tshuaj noj tiv thaiv kab mob txhua hnub, xws li Metformin lossis Siofor.
Thiab muaj kev puas tsuaj rau cov pob qij txha, nrog rau kev mob caj dab, tshuaj los tiv thaiv thiab tshuaj uas txuas ntxiv cov pob txha mos tau raug kho. Hauv kev kis tus kab mob siab, kev txhaj tshuaj yog tsim, tab sis tsuas yog tias cov kev sib tshuam nyob ntawm tus kheej.
Tsis tas li, kev kho mob ntawm kev sib koom ua ke hauv cov ntshav qab zib feem ntau tau nqis los noj pyrazolone derivatives thiab vitamin B 12. Corticosteroids tsis tshua muaj siv rau atropathy, vim lawv cuam tshuam rau qab zib. Tab sis yog tias tsim nyog, cia siab- thiab kev tswj hwm ntawm cov koob tshuaj tsawg kawg nkaus (txog 37 ml ntawm hydrocortisone) qee zaum qhia.
Rau kev kho cov tshuaj kom ua haujlwm tau zoo, tus neeg mob yuav tsum noj cov tshuaj hauv cov chav kawm thiab ntev. Tib lub sijhawm, nws yuav tsum tau sim tshuaj system, uas yuav ua rau tus kws kho mob tuaj yeem los kho tus txheej txheem kho.
Nyob rau hauv kev kis ntawm ko taw kev puas tsuaj, mob rwj yog kho thiab tshuaj tua kab mob yog kho. Nws tseem yuav tsum tso tseg cov cwj pwm tsis zoo, muab cov nqaj ntawm cov ceg nqaj thiab kho cov kab mob uas cuam tshuam nrog kev tsim dua tshiab ntawm kev tsim kho ulcerative.
Nrog mob caj dab los yog mob caj dab hauv cov ntshav qab zib mellitus, txoj kev kho mob tsis siv tshuaj siv tau. Ib qho ntawm txoj kev nrov tshaj plaws yog kev kho cov khoom sib nqus, thaum lub sij hawm cov pob qij txha tau kho ntawm qhov tob ntawm kaum ob centimeters.
Cov txiaj ntsig ntawm kev sib nqus raug:
- tshem tawm kev mob o;
- tshem tawm ntawm qhov mob;
- txhim kho dav dav ntawm cov leeg hlwb pob txha;
- cov txheej txheem tuaj yeem nqa ntawm yuav luag txhua lub hnub nyoog.
Lub chav kawm ntawm kev kho mob kav txog 30 hnub. Txawm li cas los xij, qhov sib nqus sib nqus tau pab tsuas yog thaum pib ntawm kev txhim kho ntawm kab mob sib koom tes. Ntxiv mus, tus txheej txheem no yog contraindicated nyob rau hauv cov ntaub ntawv ntawm lub plawv teeb meem, mob cancer, mob ntsws, tsis zoo ntshav coagulation thiab thaum cev xeeb tub.
Yog tias tus mob ntshav qab zib muaj kev sib koom ua ke, feem ntau nws tau txais kev kho mob laser. Cov txheej txheem zoo sib xws yog nqa tawm hauv cov chav kawm - 20 ntu txhua hnub. Tab sis lawv siv tau tsuas yog ua hom mob sib khuav xwb.
Ntxiv rau kev noj tshuaj antihyperglycemic, xws li Metformin, cov vitamins, cov tshuaj loog thiab tshuaj tiv thaiv kab mob, rau cov neeg mob ntshav qab zib nrog cov teeb meem sib koom tes, nws yog ib qho tseem ceeb kom ua raws txhua txoj cai rau kev saib xyuas ko taw, them nyiaj tshwj xeeb rau ko taw. Nws tseem yuav tsum tau ua kev tawm dag zog tshwj xeeb yog tias muaj ib qho prosthesis tau raug teeb tsa, tshwj xeeb tshaj yog thaum lub caij cog tsau tau tso tsis ntev los no.
Tsis tas li ntawd, nrog cov teeb meem sib koom tes, kev kho zaws tau qhia. Yog li, yog tias koj ua cov txheej txheem zoo sib xws tsawg kawg 10 feeb hauv ib hnub, koj tuaj yeem txo qhov sib zog qhov mob thiab nce qhov rhiab ntawm cov pob qij txha. Txawm li cas los xij, xws li kev kho mob yog contraindicated hauv kev mob ntshav ruaj khov kho ntshav, ua npaws, ntshav thiab tawv nqaij mob.
Kev tiv thaiv ntawm kev tshwm sim ntawm articular teeb meem nyob rau hauv cov ntshav qab zib muaj nyob rau hauv kev ceev faj glycemic, yog li koj tuaj yeem tsis tsuas yog tshem tawm cov teeb meem, tab sis kuj tiv thaiv nws qhov tshwm sim yav tom ntej. Rau lub hom phiaj no, nws yog ib qho tsim nyog yuav tsum ua raws li kev noj haus, ua kom ib ce muaj zog, zam kom tsis txhob muaj kev ntxhov siab, noj tshuaj Metformin, Metglib thiab lwm yam tshuaj tiv thaiv kab mob.
Ntshav qab zib li cas rau cov pob qij txha qhia cov kws tshaj lij hauv cov yeeb yaj kiab hauv tsab xov xwm no.
